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Goldenson NI, Shiffman S, Sembower MA, Black RA. Assessment of abuse liability and switching potential of menthol-flavored pod-based electronic nicotine delivery systems among US adults who smoke cigarettes. Drug Alcohol Depend 2024; 258:111279. [PMID: 38614020 DOI: 10.1016/j.drugalcdep.2024.111279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Menthol-flavored electronic nicotine delivery systems (ENDS) are a focus of public health and regulatory policy considerations. The abuse liability of five menthol-flavored pod-based ENDS was compared to combustible cigarettes, and switching potential of ENDS was also evaluated. METHODS 215 US adults who smoke cigarettes (34.4% female; mean age[SD]=29.60[8.75]; 40.9% non-Hispanic White; mean cigarettes/day[SD]=12.04[8.52]) completed a randomized 6-arm within-person cross-over product-use study. Participants used five pod-based menthol-flavored ENDS (JUUL2 Polar Menthol 1.5%, JUUL2 Prototype Fresh Menthol 3.0%, JUUL Menthol 5.0%, Vuse Alto Menthol 5.0%, NJOY Ace Menthol 5.0%) and their usual brand (UB) cigarette for 20minutes ad libitum. After each product use, subjective reinforcing effects relevant to abuse liability and associated with switching away from cigarettes (e.g., satisfaction, product liking) were assessed. RESULTS All ENDS products were rated substantially and statistically significantly lower than UB cigarette on measures of subjective reinforcing effects (ps<0.001). Satisfying effects of JUUL2 1.5% were rated significantly higher than other ENDS products. JUUL2 Prototype 3.0% and Vuse Alto 5.0% did not significantly differ (ps>0.05), and both were rated significantly higher than JUUL 5.0% and NJOY Ace 5.0% (ps<0.05). Differences in subjective responses to study products did not significantly differ by preference for menthol cigarettes or by current ENDS use. CONCLUSIONS Abuse liability of all menthol-flavored ENDS in this study was substantially lower than combustible cigarettes. Abuse liability of JUUL2 1.5% was within the range of currently marketed pod-based menthol-flavored ENDS products. JUUL2 1.5% likely has high potential for facilitating switching among US adults who smoke.
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Shiffman S, Oliveri DR, Goldenson NI, Liang Q, Black RA, Mishra S. Comparing Adult Smokers Who Switched to JUUL versus Continuing Smokers: Biomarkers of Exposure and of Potential Harm and Respiratory Symptoms. Nicotine Tob Res 2024; 26:494-502. [PMID: 37837438 DOI: 10.1093/ntr/ntad197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES Real-world evidence on exposure to harmful and potentially harmful constituents (HPHCs) and on biological effects in cigarette smokers who switch to electronic nicotine delivery systems (ENDS) can inform the health effects of switching. AIMS AND METHODS This cross-sectional, observational study assessed adults who had smoked ≥10 cigarettes/day for ≥10 years, comparing 124 continuing cigarette smokers (Smokers) to 140 former smokers who switched to JUUL-brand ENDS exclusively for ≥6 months (Switchers). Assessments included biomarkers of exposure (BOEs) to select HPHCs, biomarkers of potential harm (BOPHs) related to smoking-related diseases, psychometric assessments of dependence on cigarettes and ENDS, respectively, and respiratory symptoms. Planned analyses compared geometric means, adjusted for demographic covariates; further analyses adjusted for additional lifestyle and smoking history covariates. RESULTS Nicotine levels were significantly higher in Switchers (median time switched = 3 years), who were unusually heavy users of JUUL. All other BOEs, including NNAL and HPMA3 (primary endpoints), were significantly lower in Switchers than Smokers. Most BOPHs (sICAM-1 [primary], and eg, white blood cell count, MCP1, HbA1c) were significantly lower in Switchers than Smokers; HDL was significantly higher. Switchers reported significantly lower dependence on JUUL than Smokers did on cigarettes, and respiratory symptom scores were significantly lower among Switchers than Smokers. CONCLUSIONS Compared to continuing smokers, smokers who switched to JUUL had substantially lower exposures to multiple HPHCs, favorable differences in markers of inflammation, endothelial function, oxidative stress, and cardiovascular risk, and fewer respiratory symptoms. These findings suggest that switching from cigarettes to JUUL likely reduces smokers' health risks. IMPLICATIONS Short-term confinement studies and randomized clinical trials demonstrate that adult smokers who switch completely to ENDS experience substantial reductions in exposure to many smoking-related toxicants. This study extends those findings to longer periods of switching to JUUL-brand ENDS (almost 3 years on average) under naturalistic use conditions in real-world settings and also found that switching to JUUL resulted in favorable differences in BOPHs more proximally related to smoking-induced disease, as well as in respiratory symptoms. Smokers who switch to ENDS reduce their exposure to toxicants, likely reducing their disease risk.
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Affiliation(s)
| | | | | | - Qiwei Liang
- Population and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Ryan A Black
- Behavioral and Clinical Sciences, Juul Labs, Inc., Washington, DC, USA
| | - Snigdha Mishra
- Regulatory Sciences, Juul Labs, Inc., Washington, DC, USA
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Xu Y, Goldenson NI, Prakash S, Augustson EM, Shiffman S. Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes. Exp Clin Psychopharmacol 2024; 32:3-15. [PMID: 38127516 DOI: 10.1037/pha0000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Observational studies show high rates of switching away from cigarettes among adult purchasers of JUUL-brand electronic nicotine delivery system (ENDS); data are needed to evaluate switching with JUUL in randomized general population trials. The association of ENDS flavor availability and switching is pertinent. This study assessed switch rates and smoking reduction among participants randomized to use JUUL in a choice of flavors or tobacco-only, compared to a condition provided smoking-cessation materials. U.S. adults who smoke cigarettes (N = 837; Mage [SD] = 45.99 years [11.48]; 18.76 cigarettes/day [SD = 7.86]; 50.2% female) from an address-based representative panel were randomized to receive JUUL for 6 months (5.0% nicotine; only Virginia Tobacco [N = 285] or choice of flavors [N = 281]), or smoking-cessation materials (quit advice [QA]; N = 271). Self-reported past 30-day smoking and cigarette consumption were assessed at 1, 3, and 6 months. Repeated-measure regressions assessed differences in smoking outcomes between groups. Only 2% of participants were planning to quit smoking within 30 days. Across the 6-month intervention, participants randomized to JUUL (vs. QA) had 6.57-fold greater odds of reporting past 30-day switching (95% CI [3.72-11.63]). Participants in the JUUL (vs. QA) group smoked 27% fewer cigarettes/day versus baseline (Rate Ratio [95% CI] = 0.73 [0.68-0.77]). Over half (51.8%) of the Virginia Tobacco group used other flavors (36.7% nontobacco flavors), contaminating randomized flavor-conditions. JUUL flavor groups did not differ in smoking outcomes (p > .48). Use of JUUL products may support complete switching away from cigarettes, including among those not ready to quit smoking. Results suggest a preference for nontobacco-flavored ENDS among adults who smoke, although smoking outcomes did not differ by flavor. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Kim S, Shiffman S, Goldenson NI. Adult smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette. Subst Use Misuse 2024; 59:805-815. [PMID: 38238646 DOI: 10.1080/10826084.2024.2303990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Background: Electronic nicotine delivery systems (ENDS) have the potential to benefit public health if smokers completely switch from cigarettes to ENDS. Methods: A cohort of adult smokers (age ≥ 21) who purchased a JUUL Starter Kit was followed for 12 months after the initial purchase. We defined "switching" as past-30-day abstinence from smoking (even if JUUL use had stopped), and analyzed factors associated with achievement and maintenance of self-reported repeated point-prevalence switching (RPPS) at three follow-ups, i.e., no past-30-day smoking at months 6, 9, and 12. Results: RPPS was reported by 21.6% of the 12,537 evaluable smokers. Smokers with lighter smoking history and lower cigarette dependence at baseline were more likely to report RPPS. RPPS was also associated with daily use of JUUL (Month-3: OR = 2.32, 95% CI = 2.02-2.68; Month-6: OR = 1.73, 95% CI = 1.42-2.10), and with greater subjective reinforcing effects from JUUL use (assessed by the mCEQ, Month-3: OR = 1.46, 95% CI = 1.38-1.56; Month-6: OR = 1.11; 95% CI = 1.02-1.20). Even among smokers who did not meet the criteria of RPPS (i.e., who smoked at least once), 35.5% reported past 30-day point-prevalence switching on at least one follow-up, and their cigarette consumption was substantially reduced compared to baseline. Conclusions: Approximately one-fifth of adult smokers reported 30-day point-prevalence abstinence at 6, 9, and 12 months after purchasing JUUL. Greater use of JUUL and stronger subjective reinforcing effects were associated with nonsmoking, validating the potential for ENDS to substitute for smoking, with potential for positive impacts on individual and population health.
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Affiliation(s)
- Sooyong Kim
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
| | - Saul Shiffman
- PinneyAssociates, Inc., Pittsburgh, Pennsylvania, USA
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Holt NM, Shiffman S, Black RA, Goldenson NI, Sembower MA, Oldham MJ. Comparison of biomarkers of exposure among US adult smokers, users of electronic nicotine delivery systems, dual users and nonusers, 2018-2019. Sci Rep 2023; 13:7297. [PMID: 37147399 PMCID: PMC10163269 DOI: 10.1038/s41598-023-34427-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
The harm caused by cigarette smoking is overwhelmingly due to byproducts of tobacco combustion. Electronic Nicotine Delivery Systems (ENDS) provide nicotine to users without combustion, and may support tobacco harm reduction among cigarette smokers who would not otherwise quit in the near term. Analyses of Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study compared biomarkers of exposure (BOE) levels for nicotine, 3 metals, 2 tobacco-specific nitrosamines and 14 smoking-related volatile organic compounds in 151 exclusive ENDS users, 1341 exclusive cigarette smokers, 115 dual users (cigarettes and ENDS), and 1846 past 30-day nonusers of tobacco, adjusting for demographics. Nicotine exposure in ENDS users and dual users did not significantly differ from smokers. Among ENDS users, 16 of 18 other BOEs were significantly lower than smokers'; 9 BOEs were not significantly different from nonusers. Among dual users smoking < 10 cigarettes/day, 15 of 18 non-nicotine BOEs were significantly lower than smokers', whereas in dual users smoking ≥ 10 cigarettes per day none of the BOEs significantly differed from smokers'. In this representative sample of US adults, exclusive use of ENDS (vs. cigarette smoking) was associated with much lower exposures to many harmful chemicals associated with smoking-related disease. BOE levels in dual users were directly related to their cigarette consumption. These BOE data provide further evidence that ENDS expose users to substantially lower levels of toxicants than combustible cigarettes, confirming their potential for harm reduction.
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Shiffman S, Goldenson NI. Changes in Dependence Over One Year among US Adults Who Smoke Cigarettes and Switched Completely or Partially to Use of the JUUL-Brand Electronic Nicotine Delivery System. Drug and Alcohol Dependence Reports 2023; 6:100137. [PMID: 36994368 PMCID: PMC10040328 DOI: 10.1016/j.dadr.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Background Electronic nicotine delivery systems (ENDS) are substitute sources of nicotine for adults who smoke cigarettes. Understanding changes in dependence as people switch from cigarettes to ENDS is relevant to public health. This study assessed changes in dependence among adults who switched completely or partially (dual users) from cigarettes to JUUL-brand ENDS over 12 months. Methods US adults who smoke and purchased a JUUL Starter Kit (n = 17,619) completed a baseline assessment and were invited to 1-, 2-, 3-, 6-, 9- and 12-month follow-ups. Dependence on cigarettes at baseline and on JUUL at follow-ups was assessed with the Tobacco Dependence Index (TDI; Range 1-5). Analyses estimated the minimal important difference (MID) for the scale, compared JUUL dependence to baseline cigarette dependence and assessed changes in JUUL dependence over 1-year, including among those using JUUL at all follow-ups. Results Participants who switched at month 2 had month 1 JUUL TDI scores 0.24 points greater than those who continued smoking (p<0.001); thus MID=0.24. Among both switchers and dual users overall, dependence on JUUL 1 and 12 months later was lower than baseline dependence on cigarettes (ps<0.001); participants who smoked every day showed more consistent and larger reductions. Among participants who persistently used JUUL without smoking, dependence increased 0.01 points per month (p<0.001), but was leveling off over time. Conclusions Dependence on JUUL was lower than baseline cigarette dependence. Increases in JUUL dependence were small over 12 months of continual JUUL use. These data indicate that ENDS, including JUUL, have lower dependence potential than cigarettes.
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Affiliation(s)
- Saul Shiffman
- Pinney Associates, Inc
- Corresponding author at: Pinney Associates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States.
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Shiffman S, McCaffrey SA, Hannon MJ, Goldenson NI, Black RA. The Respiratory Symptom Experience Scale (RSES): Quantitative Psychometric Assessment and Validation of a New Questionnaire to Assess Respiratory Symptoms in Current and Former Smokers RSES (Preprint). JMIR Form Res 2022; 7:e44036. [PMID: 37058347 PMCID: PMC10148213 DOI: 10.2196/44036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). OBJECTIVE This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. METHODS The Respiratory Symptom Experience Scale (RSES) was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. RESULTS A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores -0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers' RSES scores were significantly higher than former smokers' scores (P<.001). Switchers' RSES scores were significantly lower than smokers' scores (P<.001) and no different from former smokers' scores (P=.34). CONCLUSIONS The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health.
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Affiliation(s)
- Saul Shiffman
- PinneyAssociates, Inc, Pittsburgh, PA, United States
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Goldenson NI, Augustson EM, Shiffman S. Differences in switching away from cigarettes and JUUL use characteristics among adult menthol and nonmenthol smokers who purchased the JUUL System. Drug Alcohol Depend 2022; 231:109238. [PMID: 34974269 DOI: 10.1016/j.drugalcdep.2021.109238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Studies have assessed switching away from cigarettes among adult smokers who use electronic nicotine delivery systems (ENDS), but there is little data assessing differences in likelihood of switching or ENDS use characteristics by menthol smoking. METHODS Adult (age ≥ 21) established smokers who purchased a JUUL Starter Kit (N = 15,036) completed baseline and 1-, 2-, 3-, 6-, 9- and 12-month assessments. Switching (no past-30-day cigarette smoking) and flavor use were assessed at each follow-up. Repeated-measure logistic regression models evaluated association of menthol smoking and switching across 1 year. RESULTS Across the 6 follow-ups, more menthol smokers primarily used Menthol/Mint-flavored JUULpods (53.8%) than nonmenthol smokers (22.9%). Only 6.4% of menthol smokers primarily used Tobacco flavors (vs. 25.9% of nonmenthol smokers). Across all follow-ups menthol smokers (41.2% of sample) were more likely to switch than nonmenthol smokers (42.6% vs. 38.8%: OR [95% CI] = 1.17 [1.11, 1.23]); this association remained significant after adjustment for sociodemographic, smoking and JUUL use covariates (aOR [95% CI] = 1.13 [1.05, 1.21]). Nonmenthol smokers, but not menthol smokers, were significantly more likely to switch when primarily using Menthol/Mint-flavored (vs. Tobacco-flavored) JUULpods (aOR [95% CI] = 1.14 [1.04, 1.25]). Differences in baseline smoking characteristics between menthol and nonmenthol smokers were small in magnitude. CONCLUSIONS Adult menthol (vs. nonmenthol) smokers using JUUL were more likely to switch. More than twice as many menthol (vs. nonmenthol) smokers primarily used Menthol/Mint-flavor JUULpods; few menthol smokers used tobacco flavors. Given these pronounced differences in flavor preferences, availability of ENDS in menthol flavors may be particularly important for menthol smokers, but may also benefit some nonmenthol smokers.
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Cohen G, Goldenson NI, Bailey PC, Chan S, Shiffman S. Changes in Biomarkers of Cigarette Smoke Exposure After 6 Days of Switching Exclusively or Partially to Use of the JUUL System with Two Nicotine Concentrations: A Randomized Controlled Confinement Study in Adult Smokers. Nicotine Tob Res 2021; 23:2153-2161. [PMID: 34161586 PMCID: PMC8570669 DOI: 10.1093/ntr/ntab134] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Introduction Evidence suggests that cigarette smokers who switch to electronic nicotine delivery systems (ENDS) reduce their exposure to harmful toxicants and carcinogens. It is unclear if dual-use is associated with decreases in exposure to toxicants. Methods This parallel-group confinement study assessed changes in biomarkers of exposure (BOEs) over six days among healthy adult smokers who were randomized into 1 of 11 study groups: eight JUUL-brand System (JUUL) groups (4 JUUL flavors [Virginia Tobacco, Menthol, Mint, Mango] × 2 nicotine concentrations [5.0% or 3.0% by weight]); Dual-Use group used preferred JUUL flavor (5.0% nicotine) and ≤50% usual brand (UB) cigarettes/day; UB Cigarette group and one group abstained from all tobacco/nicotine product use (Abstinence group). Urine and blood analysis assessed changes in primary BOE endpoints (NNAL, 3-HPMA, MHBMA, S-PMA COHb) and secondary BOE endpoints (NNN, HMPMA, CEMA, 1-OHP, O-toluidine, 2-NA, 4-ABP) among 279 adult smokers. Results In JUUL groups, median percent reductions in primary BOEs (Day 6–Baseline) were 90%–≥100% of Abstinence; there were no significant differences between JUUL groups and Abstinence. All reductions in JUUL groups were substantially and statistically significantly greater than reductions in the UB Cigarette group (ps < 0.025). Median reductions in primary BOEs in the Dual-Use group were 43%–55% of Abstinence. Similar results were observed for secondary BOEs. Conclusion This study suggests that the use of JUUL as a complete or partial substitute (i.e., dual-use with ≥50% reduction in cigarette consumption) for combustible cigarettes can substantially reduce exposure to multiple toxins associated with cigarette smoking. Implications This study adds to the growing body of evidence supporting the utility of ENDS products as potentially reduced-harm alternatives to cigarettes for adult smokers. Adult smokers who switched completely from cigarette smoking to use of the JUUL System (“JUUL”) in two nicotine concentrations (5.0% and 3.0%) and four flavors significantly reduced their exposure to multiple classes of cigarette-related toxicants. Additionally, smokers who used JUUL and continued smoking but reduced their daily cigarette consumption by ≥50% (dual users) also significantly reduced their toxicant exposure compared to cigarette smoking.
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Affiliation(s)
- Gal Cohen
- Juul Labs, Inc., Washington, DC, USA
- Corresponding Author: Gal Cohen, PhD, Juul Labs, Inc., 1000 F Street NW, Suite 800, Washington, D.C, 20004, USA. E-mail:
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Goldenson NI, Ding Y, Prakash S, Hatcher C, Augustson EM, Shiffman S. Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom. Nicotine Tob Res 2021; 23:1821-1830. [PMID: 34002223 PMCID: PMC8653762 DOI: 10.1093/ntr/ntab062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction Electronic nicotine delivery systems (ENDS) may improve public health if they
facilitate smokers switching away from cigarettes. Conceptually, switching
is facilitated when ENDS provide adequate nicotine delivery. Switching rates
among smokers who purchased the JUUL System (“JUUL”) were
compared in the United Kingdom (UK), where regulations limit nicotine
concentration to 20 mg/mL versus North America (N.Am.; United States and
Canada), where higher concentrations are available. Aims and Methods Adult established smokers (age ≥21, smoked ≥100 cigarettes,
smoking some days or every day at baseline) who newly purchased JUUL were
recruited into a longitudinal study (UK: N = 1247; N.Am.:
N = 8835). Complete switching (no smoking for
≥30 days) was assessed 1, 3, and 6 months after purchase; propensity
score matching (PSM) and logistic regression compared switching after
adjusting for baseline characteristics. Results In both N.Am. and UK, ≥82% of participants reported using the highest
JUUL nicotine concentration available (UK: 18 mg/mL; N.Am.: 59 mg/mL).
Unadjusted switching rates did not differ at 1 month (17%–18%);
unadjusted and adjusted rates were significantly higher in N.Am. (vs. UK) at
3 and 6 months. In the PSM sample, after additional covariate adjustment,
rates were significantly higher in N.Am. (vs. UK) at 3 months (31.5% vs.
22.7%; odds ratio [95% confidence interval, CI] = 1.59 [1.25, 2.02]) and 6
months (38.0% vs. 26.0%; odds ratio [95% CI] = 1.79 [1.37, 2.35]). Conclusions These results suggest availability of ENDS in nicotine concentrations greater
than 20 mg/mL may be associated with increased switching among adult
smokers. Differences in smoking and ENDS use characteristics did not explain
associations of location and switching; however, between-country differences
may be affected by unmeasured factors. Implications Switching rates were lower among smokers who purchased the JUUL System
(“JUUL”) in the UK, where regulations limit nicotine
concentration to 20 mg/mL versus N.Am. (United States and Canada), where
higher concentrations are available—before and after controlling for
differences in smoking and ENDS use characteristics. These results suggest
availability of ENDS in nicotine concentrations greater than 20 mg/mL may be
associated with increased switching among adult smokers. Between-country
differences may be affected by unmeasured factors; future research should
consider these factors and the extent to which regulatory policy
environments may explain differences in switching among adult smokers.
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Affiliation(s)
| | - Yu Ding
- Juul Labs, Inc., Washington, DC, USA
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Shiffman S, Goldenson NI, Hatcher C, Augustson EM. Changes in Dependence as Smokers Switch from Cigarettes to JUUL in Two Nicotine Concentrations. Am J Health Behav 2021; 45:563-575. [PMID: 33894800 DOI: 10.5993/ajhb.45.3.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we assessed changes in dependence as smokers transitioned from cigarette smoking to exclusive use of the JUUL System ("JUUL"), contrasting users of 5.0% versus 3.0% nicotine concentration pods. Methods: Overall, 5246 adult (age ≥ 21) established smokers (> 100 cigarettes lifetime) who purchased a JUUL device completed online surveys at baseline, when smoking, and one and 3 months later; 1758 reported no past-30-day smoking ('switching') at one or both timepoints. Analyses compared dependence on cigarettes (at baseline) and JUUL (at follow-up), as assessed by the 4-item PROMIS scale (Range: 0-4). Results: Switching increased from Month 1 (18.3%) to Month 3 (28.6%); switchers at one month (Difference = 0.23) and 3 months (0.24) showed lower mean baseline cigarette dependence. Dependence decreased significantly (ps < .001) from baseline cigarette dependence to JUUL dependence at both one (from 1.82 to 1.59) and 3 months (1.97 to 1.73); changes did not significantly differ between users of 5.0% and 3.0% (ps > .43). Dependence on JUUL did not change significantly from Month 1 to Month 3. Conclusions: Dependence decreased as smokers transitioned from smoking to exclusive use of JUUL, similarly for users of both nicotine concentrations. Smokers who switch to JUUL may reduce their nicotine dependence.
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Affiliation(s)
- Saul Shiffman
- Senior Scientific Advisor, PinneyAssociates Inc, Pittsburgh, PA, United States
| | | | - Cameron Hatcher
- Behavioral Science Research Associate, Juul Labs Inc, Washington, DC, United States
| | - Erik M. Augustson
- Senior Director, Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
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Shiffman S, Sembower MA, Augustson EM, Goldenson NI, Haseen F, McKeganey NP, Russell C. The Adult JUUL Switching and Smoking Trajectories (ADJUSST) Study: Methods and Analysis of Loss-to-Follow-up. Am J Health Behav 2021; 45:419-442. [PMID: 33894793 DOI: 10.5993/ajhb.45.3.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The Adult JUUL System User Switching and Smoking Trajectories (ADJUSST) study assessed the smoking and JUUL use trajectories of adults who purchased JUUL. In this paper, we describe study methods, characterize the sample, and assesses potential for bias due to loss to follow-up. Methods: We entered 55,414 US adults (≥ age 21) who purchased a JUUL Starter Kit for the first time (online or at retail) in 2018 into a naturalistic, longitudinal observational study, irrespective of baseline smoking status. Participants were invited for follow-ups 1, 2, 3, 6, 9, and 12 months later, focused on assessing past-30-day smoking and JUUL use. Analyses assessed potential bias due to non-response. Results: Over 90% of participants had a history of smoking; 62.8% were past-30-day smokers; 23.3% were former smokers. Participants' average age was 30; 75% were white. Most participants (77.6%) completed some follow-ups; 25% completed all follow-ups. Baseline differences among complete responders (N = 13,729), partial responders (N = 29,252), and complete non-responders (N = 12,433) were small. When recontacted, few 12-month non-responders said their non-response was due to smoking; many reported no past-30-day smoking. Conclusions: The study may elucidate smoking trajectories of adult JUUL users. The potential for bias due to loss to follow-up in ADJUSST was limited.
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Affiliation(s)
- Saul Shiffman
- Senior Scientific Advisor, Behavioral Science, Study Design, and Analysis, PinneyAssociates Inc, Pittsburgh, PA, United States
| | - Mark A. Sembower
- Director, Data Management and Statistical Analysis, PinneyAssociates Inc, Pittsburgh, PA, United States
| | - Erik M. Augustson
- Senior Director, Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
| | | | - Farhana Haseen
- Director of Research, Centre for Substance Use Research, Glasgow, United Kingdom
| | - Neil P. McKeganey
- Director, Centre for Substance Use Research, Glasgow, United Kingdom
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Le GM, Holt NM, Goldenson NI, Smith LC, Hatcher C, Shiffman S, Augustson EM. Cigarette Smoking Trajectories in Adult Former Smokers Using the JUUL System. Am J Health Behav 2021; 45:505-526. [PMID: 33894797 DOI: 10.5993/ajhb.45.3.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: In this study, we assessed cigarette smoking over 12 months among adult former smokers who newly purchased a JUUL Starter Kit (JSK). Methods: Prevalence of past 30-day smoking and factors associated with smoking were assessed among adult (age ≥ 21) former established smokers, stratified as recent (quitting ≤ 12 months) and long-term quitters (> 12 months), who purchased a JSK and completed ≥ 1 of 6 follow-up assessments (N = 4786). Results: Recent quitters had higher rates (16.6%-19.9%) of past 30-day smoking than long-term quitters (6.4%-9.2%) across the 12-month period; smoking prevalence did not significantly increase over time in either subgroup. Few participants (6.5% of recent quitters, 2.8% of long-term quitters) reported smoking at both 9 and 12 months, a pattern that might indicate persistent smoking. Past 30-day JUUL use remained high (≥ 87%) across the 12 months. Participants who used JUUL more frequently were less likely to smoke. Conclusions: Among former smokers who purchased JUUL, prevalence rates of smoking were low and stable across the 12-month period, suggesting there was not a growing cohort of former smokers resuming smoking. Smoking was more common in recent quitters than long-term quitters. Greater use of JUUL was associated with reduced odds of smoking resumption.
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Affiliation(s)
- Gem M. Le
- Director Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
| | - Nathan M. Holt
- Principal Scientist and Biostatistician, Regulatory Science, Juul Labs Inc, Washington, DC, United States
| | | | - Lauren C. Smith
- Senior Associate, Behavioral Science Research, Juul Labs Inc, Washington, DC, United States
| | - Cameron Hatcher
- Associate, Behavioral Science Research, Juul Labs Inc, Washington, DC, United States
| | - Saul Shiffman
- Senior Scientific Advisor, Behavioral Science, Study Design, and Analysis, PinneyAssociates Inc, Pittsburgh, PA, United States
| | - Erik M. Augustson
- Senior Director, Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
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Goldenson NI, Shiffman S, Hatcher C, Lamichhane D, Gaggar A, Le GM, Prakash S, Augustson EM. Switching away from Cigarettes across 12 Months among Adult Smokers Purchasing the JUUL System. Am J Health Behav 2021; 45:443-463. [PMID: 33894794 DOI: 10.5993/ajhb.45.3.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we assessed complete switching away from cigarette smoking among adult smokers who purchased a JUUL Starter Kit (JSK). Methods: Adult (age ≥ 21) established smokers (smoked ≥ 100 lifetime cigarettes) who purchased a JSK in 2018 were invited to complete online surveys 1, 2, 3, 6, 9 and 12 months after initial JSK purchase. Point prevalence of switching (no past 30-day smoking) was assessed at each follow-up. Repeated measures logistic regression models evaluated associations of sociodemographic factors, baseline smoking characteristics and time-varying JUUL System ("JUUL") use characteristics and switching across the 12-month period. Results: Respondents (N = 17,986) were 55.0% male, 78.3% white, mean age = 32.65 years (SD = 10.81), mean baseline cigarettes/day = 11.10 (SD = 8.16). The proportion self-reporting switching increased over time: one-month (27.2%[3718/13,650]), 2-month (36.4%[4926/13,533]), 3-month (41.0%[5434/13,257]), 6-month (46.6%[5411/11,621]), 9-month (49.4%[6017/12,186]), and 12-month (51.2%[6106/11,919]); 33.1% reported switching at both 9-month and 12-month follow-ups. In prospective analyses, smokers with lower cigarette dependence, shorter smoking history, lower cigarette consumption, more frequent JUUL use, greater satisfaction from initial JUUL use, and higher JUUL dependence were significantly more likely to switch. Conclusions: Rates of switching with JUUL increased over time. Over 50% of respondents reported complete switching away from cigarettes 12 months following purchase. Greater use of and dependence on JUUL predicted switching.
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Affiliation(s)
| | - Saul Shiffman
- Senior Scientific Advisor, PinneyAssociates Inc, Pittsburgh, PA, United States
| | - Cameron Hatcher
- Behavioral Science Research Associate, Juul Labs Inc, Washington, DC, United States
| | - Dish Lamichhane
- Behavioral Science Research Associate, Juul Labs Inc, Washington, DC, United States
| | - Arzoo Gaggar
- Behavioral Science Research Associate, Juul Labs Inc, Washington, DC, United States
| | - Gem M. Le
- Director, Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
| | - Shivaani Prakash
- Director of Health Economics and Policy Research, Juul Labs Inc, Washington, DC, United States
| | - Erik M. Augustson
- Senior Director, Behavioral Affairs, Juul Labs Inc, Washington, DC, United States
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Prakash S, Xu Y, Goldenson NI, Wissmann R, Gougelet R, Shiffman S. Transitions in Smoking among Adults Newly Purchasing the JUUL System. Am J Health Behav 2021; 45:546-562. [PMID: 33894799 DOI: 10.5993/ajhb.45.3.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we prospectively assessed changes in smoking a year after US adults' first-time purchase of a JUUL Starter Kit (JSK). Methods: Descriptive analyses assessed transitions in smoking status at 12 months among adult (age ≥21) JSK purchasers providing baseline and 12-month follow-up data (N = 27,164 [49.0% of baseline]), stratified by baseline smoking status. Baseline regular use of other ENDS was also considered. Results: Purchasers included baseline past 30-day smokers (65.2%), former smokers (12.0%), and never smokers (9.7%); over 90% were ever-smokers. One year later, the majority (58%) of those smoking at baseline reported no longer smoking. Former smokers or never smokers who were smoking at 12 months represented less than 2% of respondents. Former and current smokers who were regularly using other ENDS at baseline were less likely to report smoking at 12 months. Conclusions: Past 30-day smoking prevalence in a large longitudinal study of first-time JSK purchasers fell by more than half over 12 months. Analyzing the sample composition at purchase and transitions within subgroups defined by smoking status allows for a detailed understanding to help inform assessments of the population health impact of ENDS.
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Affiliation(s)
- Shivaani Prakash
- Director of Health Economics and Policy Research, Juul Labs Inc, Washington, DC, United States
| | - Yingying Xu
- Research Economist, Juul Labs Inc, Washington, DC, United States
| | | | - Rasmus Wissmann
- Vice President Data, Juul Labs Inc, Washington, DC, United States
| | - Robyn Gougelet
- Director, Health Policy and Regulatory Strategy, PinneyAssociates Inc, Bethesda, MD, United States
| | - Saul Shiffman
- Senior Scientific Advisor, PinneyAssociates Inc, Pittsburgh, PA, United States
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Cho J, Goldenson NI, Kirkpatrick MG, Barrington-Trimis JL, Pang RD, Leventhal AM. Developmental patterns of tobacco product and cannabis use initiation in high school. Addiction 2021; 116:382-393. [PMID: 32533801 PMCID: PMC7736052 DOI: 10.1111/add.15161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
AIMS To identify prototypical developmental patterns of tobacco product and cannabis use and co-use initiation during adolescence, and determine risk factors for and consequences of these initiation patterns. DESIGN Prospective repeated-measures cohort with eight semi-annual assessments during high school. Multiple-event process survival mixture modeling identified latent initiation classes with distinct patterns of variation in timing of use initiation of tobacco products and cannabis. We then estimated: (1) associations of baseline risk factors with membership in initiation classes and (2) differences between initiation classes in frequency of cannabis and tobacco product use at the final assessment. SETTING Ten high schools in the Los Angeles, CA, USA metropolitan area, 2013-17. PARTICIPANTS Students [1031 (45.4%) males; mean (standard deviation) age at baseline = 14.6 (0.39) years] who had never used any tobacco products or cannabis at baseline 9th grade assessment (n = 2272). MEASUREMENTS Self-report measures of electronic cigarette (e-cigarette), combustible cigarette, hookah, cigar/cigarillos and cannabis use were collected at each assessment. FINDINGS Four distinct tobacco and cannabis use initiation classes were identified: (1) early and high-risk cannabis and polytobacco initiators (n = 116; 5.1%); (2) early cannabis and polytobacco initiators (n = 172; 7.6%); (3) late cannabis and e-cigarette initiators (n = 431; 19.0%); and (4) abstainers (n = 1553; 68.4%). At baseline, older age for the early and high-risk cannabis and polytobacco initiators [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.10, 1.35, P < 0.001], peer cannabis use (OR = 1.60, 95% CI = 1.23, 2.08, P < 0.001) and delinquent behavior (OR = 1.30, 95% CI = 1.08, 1.55, P = 0.004) were associated with membership in the three initiation classes (versus abstainers). Membership in the early and high-risk cannabis and polytobacco initiators class (versus three other classes) was significantly associated with increased past 30-day frequency and daily intensity of use at the final assessment (P-values < 0.001). CONCLUSIONS Older age, peer cannabis use and delinquent behavior appear to be risk factors for the initiation of tobacco/cannabis product use among high school students in the Los Angeles metropolitan region. Early and higher-risk polyproduct use initiation appears to be associated with greater escalation of past 30-day and daily tobacco and cannabis use at the end of the high school.
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Affiliation(s)
- Junhan Cho
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Corresponding author: Junhan Cho, Ph.D., University of Southern California, Keck School of Medicine, 2001 N Soto Street, SSB302X), Los Angeles, CA 90032-9239, USA; , Phone: 323-442-8239, Fax: 323-442-2359
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Matthew G. Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Raina D. Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA
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Goldenson NI, Fearon IM, Buchhalter AR, Henningfield JE. An Open-Label, Randomized, Controlled, Crossover Study to Assess Nicotine Pharmacokinetics and Subjective Effects of the JUUL System with Three Nicotine Concentrations Relative to Combustible Cigarettes in Adult Smokers. Nicotine Tob Res 2021; 23:947-955. [PMID: 33486526 PMCID: PMC8628869 DOI: 10.1093/ntr/ntab001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Introduction This randomized, open-label, crossover clinical study evaluated nicotine
pharmacokinetics (PK) and subjective effects of the JUUL System (JS; Juul
Labs, Inc.) with three nicotine concentrations compared to the usual brand
(UB) cigarettes in 24 adult smokers. Methods At five study visits, subjects used either the JS in 59 mg/mL, JS 18 mg/mL
(two visits), and JS 9 mg/mL (all tobacco-flavored) or smoked their UB
cigarette first during a controlled puffing sequence (CPS) and then ad
libitum (5 min) use sessions. Blood samples were taken at specified
timepoints for 60 min in each session. The modified Product Evaluation Scale
assessed subjective effects 30-min post-use in the CPS session. Results Maximum plasma nicotine concentration (Cmax-BL),
total nicotine exposure (AUC0-60-BL), and rate of plasma nicotine
rise were significantly lower for all JS products compared to subjects' UB
cigarette in CPS and ad libitum use sessions. In both use sessions these PK
parameters were significantly higher for JS 59 mg/mL compared to 18 and 9
mg/mL. Subjective measures of cigarette craving relief and “Enough
Nicotine” for JS 59 mg/mL did not differ significantly from UB
cigarettes, but JS 18 and 9 mg/mL were rated significantly lower than JS 59
mg/mL and UB cigarettes. Conclusions Nicotine exposure and subjective relief were directly related to JS nicotine
concentration: higher nicotine concentrations gave rise to significantly
greater plasma nicotine levels and relief from craving. Heavier and more
dependent smokers may require the greater nicotine delivery of JS 59 mg/mL
to successfully transition away from cigarettes. Implications It has been suggested that electronic nicotine delivery systems (ENDS) and
other alternative nicotine delivery products that more closely mimic the
nicotine pharmacokinetics (PK) of cigarettes may facilitate smokers
transitioning away from cigarettes. We examined nicotine PK and subjective
effects of JUUL System (JS) ENDS with three nicotine concentrations (59, 18
and 9 mg/mL) compared to combustible cigarettes. Nicotine delivery from JS
ENDS was nicotine concentration dependent, with higher nicotine
concentrations giving rise to higher nicotine exposure. These findings
suggest that heavier and more dependent smokers may require ENDS with
nicotine concentrations greater than 20 mg/mL to successfully transition
away from cigarettes.
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Goldenson NI, Buchhalter AR, Augustson EM, Rubinstein ML, Van Hoof D, Henningfield JE. Abuse liability assessment of the JUUL system in two nicotine concentrations compared to combustible cigarette, nicotine gum and comparator electronic nicotine delivery system. Drug Alcohol Depend 2020; 217:108441. [PMID: 33250386 DOI: 10.1016/j.drugalcdep.2020.108441] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To assess the abuse liability of the JUUL System (JS) in 5.0 % (59 mg/mL) and 3.0 % (35 mg/mL) nicotine concentrations. METHODS Adult smokers (N = 146; 45.9 % female; mean age = 41.29 years) were randomized to one of four study flavor arms and then to a within-subjects cross-over sequence for five test product categories: (1) JS 5.0 % nicotine concentration; (2) JS 3.0 % nicotine; (3) usual brand (UB) cigarette; (4) 4 mg mint nicotine gum; (5) comparator ENDS (VUSE Alto 5.0 % nicotine). Products were tested by ad libitum use (5 min for ENDS and cigarette; 30 min for gum); nicotine pharmacokinetic (PK) parameters and subjective effects were assessed following use. RESULTS Maximum plasma nicotine concentration (Cmax-BL), rate of plasma nicotine rise and total nicotine exposure (AUC0-60-BL) of UB cigarette were significantly greater than all other test products. The comparator ENDS was significantly greater than 5.0 % and 3.0 % JS and nicotine gum on Cmax-BL, rate of plasma nicotine rise, and AUC0-60-BL; Cmax-BL of JS 5.0 % was significantly greater than JS 3.0 % and nicotine gum. Product liking and satisfying effects were significantly highest for the UB cigarette; JS products and comparator ENDS did not significantly differ and were rated higher than nicotine gum on most subjective measures. CONCLUSIONS These results suggest that the abuse liability of both 5.0 % and 3.0 % JS is: (1) substantially lower than UB cigarette; (2) somewhat lower than comparator ENDS; and (3) higher than nicotine gum. Additionally, the abuse liability of JS 5.0 % is somewhat higher than JS 3.0 %.
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Goldenson NI, Buchhalter AR, Augustson EM, Rubinstein ML, Henningfield JE. Abuse liability assessment of the JUUL system in four flavors relative to combustible cigarette, nicotine gum and a comparator electronic nicotine delivery system among adult smokers. Drug Alcohol Depend 2020; 217:108395. [PMID: 33176942 DOI: 10.1016/j.drugalcdep.2020.108395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The abuse liability of the JUUL System (JS) in four flavors were evaluated compared to combustible cigarettes, nicotine gum, and a comparator electronic nicotine delivery system (ENDS) with pharmacokinetics (PK) and subjective effects. METHODS Adult smokers (N = 66; 50.0 % female; mean age = 41.1; 63.6 % white) completed a 7-arm within-subjects cross-over product-use study while confined to a clinical laboratory. Participants used JS in four flavors (Virginia Tobacco, Mango, Mint, Creme, [5.0 % nicotine; 59 mg/mL]), their usual brand (UB) cigarette, a comparator ENDS (VUSE Solo; 4.8 % nicotine, tobacco-flavor), and mint nicotine gum (4 mg) under controlled use conditions. After each product use, nicotine PK and subjective effects were assessed. RESULTS Maximum plasma nicotine levels (Cmax-BL), rate of plasma nicotine rise, overall nicotine exposure (AUC0-60-BL), and subjective liking and satisfaction of JS were significantly lower than UB cigarettes. These parameters were generally greater for JS than nicotine gum; the comparator ENDS was somewhat lower but within the range of JS. Nicotine PK did not differ among the Mint, Mango, and Virginia Tobacco JS flavors. Mint and Mango were rated as more satisfying than Virginia Tobacco and Creme. CONCLUSIONS Controlled use of JS among adult smokers resulted in nicotine delivery, product liking, and satisfaction that were less than that of combustible cigarettes but generally greater than nicotine gum. These results support the conclusion that JS has lower abuse liability than combustible cigarettes, higher abuse liability than nicotine gum, and may provide sufficient nicotine delivery and satisfying effects to support substitution for combustible cigarettes among adult smokers.
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Pang RD, Goldenson NI, Kirkpatrick M, Barrington-Trimis JL, Cho J, Leventhal AM. Sex differences in the appeal of flavored e-cigarettes among young adult e-cigarette users. Psychol Addict Behav 2020; 34:303-307. [PMID: 31961168 DOI: 10.1037/adb0000548] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Experimental evidence suggests that females (vs. males) may be more sensitive to and derive greater reinforcement from the sensory aspects of combustible cigarette smoking (e.g., flavor, taste). However, it is unknown if there are similar sex differences in the appeal of flavored e-cigarettes. Young adult male (N = 65) and female (N = 35) e-cigarette users (mean age = 25.4; 53% current smokers) attended 1 laboratory session in which they self-administered standardized e-cigarette doses according to a Flavor (fruit vs. tobacco vs. menthol) × Nicotine (6 mg/mL vs. 0 mg/mL) × Voltage (3.3 V vs. 4.3 V) within-participant fully crossed factorial design. Following each trial, participants completed ratings of appeal (mean of liking, disliking [reverse scored], and willingness-to-use-again ratings). Sex was tested as a between-subjects moderator of the effects of flavor on appeal. There was a significant interaction between sex and flavor for e-cigarette appeal (p < .001). In males, fruit-flavored e-cigarettes generated greater appeal than menthol and tobacco (ps < .001). In females, both fruit- and menthol-flavored e-cigarettes generated greater appeal than tobacco (ps < .001), but there was no significant difference between fruit- and menthol-flavored e-cigarettes (p = .40). The findings of this study suggest that males prefer fruit-flavored e-cigarettes, and females prefer both menthol- and fruit-flavored e-cigarettes. The impact of regulatory policies targeting e-cigarette flavors in the population may vary by sex. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Goldenson NI, Khoddam R, Stone MD, Leventhal AM. Associations of ADHD Symptoms With Smoking and Alternative Tobacco Product Use Initiation During Adolescence. J Pediatr Psychol 2019; 43:613-624. [PMID: 29304219 DOI: 10.1093/jpepsy/jsx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023] Open
Abstract
Objective Recently, use of alternative tobacco products, such as electronic cigarettes (e-cigarettes) and hookah (water-pipe tobacco), has increased among adolescents. It is unknown whether attention-deficit hyperactivity disorder (ADHD) symptoms are associated with initiation of alternative tobacco product use. Methods Ninth grade high school students who never used any tobacco product at baseline (N = 1,921) participated in a longitudinal survey from 2014 to 2015. Overall symptomatology and inattention (IN) and hyperactivity-impulsivity (HI) ADHD subtypes were assessed at baseline. Past 6-month e-cigarette, hookah, and combustible cigarette use (yes/no) were reported at three semi-annual follow-ups. Repeated measures logistic regression models assessed the association of baseline ADHD symptoms with likelihood of tobacco product initiation across follow-ups. Results For ADHD main effect estimates, unadjusted odds of reporting e-cigarette, hookah, and combustible cigarette use pooled across follow-up time points were 45%, 33%, and 37% greater, respectively, with each increase in one SD-unit of baseline ADHD symptoms in baseline never-users of tobacco products. ADHD was not associated with hookah or combustible cigarette use after adjusting for other risk factors. After adjustment, e-cigarette use initiation remained associated with overall ADHD (odds ratio, OR [95%confidence interval, 95% CI] = 1.22 [1.04, 1.42]) and HI (OR [95% CI] = 1.26 [1.09, 1.47]) symptoms, but not IN symptoms (OR [95% CI] = 1.13 [0.97, 1.32]). ADHD × Time interactions were not significant, suggesting ADHD increased odds of e-cigarette use initiation but did not alter the shape of use trajectory across follow-up among initiators. Conclusions Understanding the psychosocial mechanisms underlying the pathway from ADHD to e-cigarette use may advance tobacco product use etiologic theory and prevention practice in the current era in which e-cigarette use is popular among youth.
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Affiliation(s)
- Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Rubin Khoddam
- Department of Psychology, University of Southern California
| | - Matthew D Stone
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine.,Department of Psychology, University of Southern California
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Leventhal AM, Goldenson NI, Cho J, Kirkpatrick MG, McConnell RS, Stone MD, Pang RD, Audrain-McGovern J, Barrington-Trimis JL. Flavored E-cigarette Use and Progression of Vaping in Adolescents. Pediatrics 2019; 144:e20190789. [PMID: 31659004 PMCID: PMC6856781 DOI: 10.1542/peds.2019-0789] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown. METHODS High school students in Los Angeles, California, completed 5 semiannual surveys (2014-2017 [10th grade to 12th grade]). Among past-6-month e-cigarette users at survey waves 1 to 4 (N = 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors [fruit, candy, sweet or dessert, buttery, blends or combinations, and other] versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5. RESULTS Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 [95% confidence interval 1.20 to 10.31]) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 [SD 5.5] vs 1.5 [SD 3.8]; adjusted rate ratio = 2.41 [95% confidence interval 1.08 to 5.92]) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day. CONCLUSIONS Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
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Affiliation(s)
- Adam M Leventhal
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California;
- Departments of Psychology and
| | - Nicholas I Goldenson
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Junhan Cho
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew G Kirkpatrick
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rob S McConnell
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew D Stone
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California; and
| | - Raina D Pang
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Leventhal AM, Goldenson NI, Barrington-Trimis JL, Pang RD, Kirkpatrick MG. Effects of non-tobacco flavors and nicotine on e-cigarette product appeal among young adult never, former, and current smokers. Drug Alcohol Depend 2019; 203:99-106. [PMID: 31434028 PMCID: PMC7489757 DOI: 10.1016/j.drugalcdep.2019.05.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND E-cigarette regulations targeting products that disproportionately appeal to never-smokers may optimize population health. This laboratory study of young adults tested whether differences in appeal between e-cigarettes with non-tobacco-flavored (vs. tobacco-flavored) and nicotine-containing (vs. nicotine-free) solutions varied by smoking history. METHODS Current (N = 53), former (N = 25), and never (N = 22) cigarette smokers who vape (Mean[SD] age = 25.4[4.4] years) administered standardized e-cigarette doses varied by a Flavor (fruit, menthol, tobacco) × Nicotine (nicotine-containing [6 mg/mL], nicotine-free) within-subject double-blind design. Participants rated each dose's appeal (0-100 scale). Covariate-adjusted interactions tested whether smoking history moderated flavor and nicotine effects. RESULTS Appeal was higher for fruit and menthol than tobacco flavors in each group. The fruit vs. tobacco appeal difference was greater in never smokers (fruit-tobacco estimate = 19.6) than current smokers (estimate = 12.1) but not former smokers (estimate = 12.6). The menthol vs. tobacco difference was greater in never smokers (menthol-tobacco estimate = 17.3) than former (estimate = 6.0) and current (estimate = 7.2) smokers. Appeal was lower for nicotine-containing than nicotine-free solutions in each group; this difference was greater in never smokers (nicotine-nicotine-free estimate = -17.3) than former (estimate = -7.0) and current (estimate = -10.6) smokers. Compared to tobacco flavors, nicotine's appeal-reducing effects were suppressed by fruit and menthol flavors in never smokers. CONCLUSIONS Higher appeal of non-tobacco-flavored (vs. tobacco-flavored) and lower appeal of nicotine-containing (vs. nicotine-free) e-cigarettes may be widespread in young adults but disproportionately amplified in never smokers. Non-tobacco flavors may suppress nicotine's appeal-lowering qualities in never smokers. The impact of regulating non-tobacco flavors in e-cigarettes may vary by smoking history.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Cho J, Goldenson NI, Stone MD, McConnell R, Barrington-Trimis JL, Chou CP, Sussman SY, Riggs NR, Leventhal AM. Characterizing Polytobacco Use Trajectories and Their Associations With Substance Use and Mental Health Across Mid-Adolescence. Nicotine Tob Res 2019; 20:S31-S38. [PMID: 30125023 PMCID: PMC6093375 DOI: 10.1093/ntr/ntx270] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/07/2017] [Indexed: 12/30/2022]
Abstract
Background Polytobacco product use is suspected to be common, dynamic across time, and increase risk for adverse behavioral outcomes. We statistically modeled characteristic types of polytobacco use trajectories during mid-adolescence and tested their prospective association with substance use and mental health problems. Methods Adolescents (N = 3393) in Los Angeles, CA, were surveyed semiannually from 9th to 11th grade. Past 6-month combustible cigarette, e-cigarette, or hookah use (yes/no) over four assessments were analyzed using parallel growth mixture modeling to identify a parsimonious set of polytobacco use trajectories. A tobacco product use trajectory group was used to predict substance use and mental health at the fifth assessment. Results Three profiles were identified: (1) tobacco nonusers (N = 2291, 67.5%) with the lowest use prevalence (<3%) of all products across all timepoints; (2) polyproduct users (N = 920, 27.1%) with moderate use prevalence of each product (8–35%) that escalated for combustible cigarettes but decreased for e-cigarettes and hookah across time; and (3) chronic polyproduct users (N = 182, 5.4%) with high prevalence of each product use (38–86%) that escalated for combustible cigarettes and e-cigarettes. Nonusers, polyproduct users, and chronic polyproduct users reported successively higher alcohol, marijuana, and illicit drug use and ADHD at the final follow-up, respectively. Both tobacco using groups (vs. nonusers) reported greater odds of depression and anxiety at the final follow-up but did not differ from each other. Conclusions Adolescent polytobacco use may involve a common moderate risk trajectory and a less common high-risk chronic trajectory. Both trajectories predict substance use and mental health symptomology. Implications Variation in use and co-use of combustible cigarette, e-cigarette, and hookah use in mid-adolescence can be parsimoniously characterized by a small set common trajectory profiles in which polyproduct use are predominant patterns of tobacco product use, which predict adverse behavioral outcomes. Prevention and policy addressing polytobacco use (relative to single product use) may be optimal tobacco control strategies for youth, which may in turn prevent other forms of substance use and mental health problems.
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Affiliation(s)
- Junhan Cho
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Matthew D Stone
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, San Diego, CA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,School of Social Work, University of Southern California, Los Angeles, CA
| | - Steven Y Sussman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,School of Social Work, University of Southern California, Los Angeles, CA.,Department of Psychology, University of Southern California, Los Angeles, CA
| | - Nathaniel R Riggs
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,Department of Psychology, University of Southern California, Los Angeles, CA
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Leventhal AM, Goldenson NI, Aguirre CG, Huh J, Kirkpatrick MG. Initial application of a human laboratory model for estimating the motivational substitutability of e-cigarettes for combustible cigarettes. Exp Clin Psychopharmacol 2019; 27:125-135. [PMID: 30688503 PMCID: PMC6599596 DOI: 10.1037/pha0000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This pilot study tested a novel human laboratory model for estimating the extent to which electronic cigarettes (e-cigarettes) serve as motivational substitutes for combustible cigarettes. The model assesses 3 parameters of substitutability, including the: (a) increase in motivational reward value of e-cigarettes after tobacco deprivation; (b) reduction in the reward value of combustible cigarettes after e-cigarette administration; and (c) comparability of the withdrawal-suppressing effects of e-cigarettes versus combustible cigarettes. Dual users (daily smokers, vaped 4+ days/week, M age = 35.3) attended 4 visits after 16-h tobacco product abstinence. For 2 visits, participants completed withdrawal measures and a task assessing smoking's reward value preceded by either: satiation by vaping or sustained tobacco product deprivation. For 2 other visits, participants completed withdrawal measures and a task assessing vaping's reward value preceded by either: continued deprivation versus satiation by smoking. Tobacco product deprivation (vs. satiation by smoking) increased vaping's reward value, indicated by nonsignificantly greater likelihood of initiating vaping versus abstaining for money (d = -.26; adjusted p [padj] = .08) and more vaping episodes purchased (β = .22; padj = .08). Satiation by vaping (vs. deprivation) nonsignificantly reduced smoking initiation (d = .46; padj = .09) and significantly decreased number of cigarettes purchased (β = -.29; padj = .04). Relative to deprivation, vaping suppressed withdrawal-related negative affect, smoking and vape urge, and anhedonia (ds ≥ .54). The magnitude of vaping-induced and smoking-induced withdrawal suppression did not significantly differ for all outcomes other than smoking urge, which was more strongly reduced by smoking (d = -1.57) than vaping (d = -.64). Future application and extension of this model may advance tobacco regulatory science and policy addressing e-cigarette use among smokers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Claudia G Aguirre
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
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26
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MacKillop J, Goldenson NI, Kirkpatrick MG, Leventhal AM. Validation of a behavioral economic purchase task for assessing drug abuse liability. Addict Biol 2019; 24:303-314. [PMID: 29314376 DOI: 10.1111/adb.12592] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/17/2017] [Accepted: 11/26/2017] [Indexed: 12/18/2022]
Abstract
Behavioral economic purchase tasks quantify drug demand (i.e. reinforcing value of a drug) and have been used extensively to assess the value of various drugs among current users. However, purchase tasks have been rarely used with unfamiliar drugs to address a compound's abuse liability, and the current study sought to validate the paradigm in this capacity. Using a double-blind placebo-controlled within-subjects drug challenge design, the study evaluated differential drug demand on an experimental drug purchase task for a 20 mg dose of oral D-amphetamine (versus placebo), a prototypic psychostimulant, in 98 stimulant-naïve participants. Compared with placebo, amphetamine significantly increased intensity, breakpoint and Omax , and significantly decreased elasticity. Mechanistic analyses revealed that Omax and breakpoint mediated the relationship between subjective drug effects and 'willingness to take again', a putative indicator of liability via motivation for future drug-seeking behavior. These findings validate the purchase task paradigm for quantifying the reinforcing value and, in turn, abuse liability of unfamiliar compounds, providing a foundation for a variety of future applications.
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Affiliation(s)
- James MacKillop
- Peter Boris Centre for Addictions Research; McMaster University/St. Joseph's Healthcare Hamilton; Hamilton Canada
| | - Nicholas I. Goldenson
- Department of Preventive Medicine; University of Southern California Keck School of Medicine; Los Angeles CA USA
| | - Matthew G. Kirkpatrick
- Department of Preventive Medicine; University of Southern California Keck School of Medicine; Los Angeles CA USA
| | - Adam M. Leventhal
- Department of Preventive Medicine; University of Southern California Keck School of Medicine; Los Angeles CA USA
- Department of Psychology; University of Southern California; Los Angeles CA USA
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27
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Ra CK, Cho J, Stone MD, De La Cerda J, Goldenson NI, Moroney E, Tung I, Lee SS, Leventhal AM. Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA 2018; 320:255-263. [PMID: 30027248 PMCID: PMC6553065 DOI: 10.1001/jama.2018.8931] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Modern digital platforms are easily accessible and intensely stimulating; it is unknown whether frequent use of digital media may be associated with symptoms of attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE To determine whether the frequency of using digital media among 15- and 16-year-olds without significant ADHD symptoms is associated with subsequent occurrence of ADHD symptoms during a 24-month follow-up. DESIGN, SETTING, AND PARTICIPANTS Longitudinal cohort of students in 10 Los Angeles County, California, high schools recruited through convenience sampling. Baseline and 6-, 12-, 18-, and 24-month follow-up surveys were administered from September 2014 (10th grade) to December 2016 (12th grade). Of 4100 eligible students, 3051 10th-graders (74%) were surveyed at the baseline assessment. EXPOSURES Self-reported use of 14 different modern digital media activities at a high-frequency rate over the preceding week was defined as many times a day (yes/no) and was summed in a cumulative index (range, 0-14). MAIN OUTCOMES AND MEASURES Self-rated frequency of 18 ADHD symptoms (never/rare, sometimes, often, very often) in the 6 months preceding the survey. The total numbers of 9 inattentive symptoms (range, 0-9) and 9 hyperactive-impulsive symptoms (range, 0-9) that students rated as experiencing often or very often were calculated. Students who had reported experiencing often or very often 6 or more symptoms in either category were classified as being ADHD symptom-positive. RESULTS Among the 2587 adolescents (63% eligible students; 54.4% girls; mean [SD] age 15.5 years [0.5 years]) who did not have significant symptoms of ADHD at baseline, the median follow-up was 22.6 months (interquartile range [IQR], 21.8-23.0, months). The mean (SD) number of baseline digital media activities used at a high-frequency rate was 3.62 (3.30); 1398 students (54.1%) indicated high frequency of checking social media (95% CI, 52.1%-56.0%), which was the most common media activity. High-frequency engagement in each additional digital media activity at baseline was associated with a significantly higher odds of having symptoms of ADHD across follow-ups (OR, 1.11; 95% CI, 1.06-1.16). This association persisted after covariate adjustment (OR, 1.10; 95% CI, 1.05-1.15). The 495 students who reported no high-frequency media use at baseline had a 4.6% mean rate of having ADHD symptoms across follow-ups vs 9.5% among the 114 who reported 7 high-frequency activities (difference; 4.9%; 95% CI, 2.5%-7.3%) and vs 10.5% among the 51 students who reported 14 high-frequency activities (difference, 5.9%; 95% CI, 2.6%-9.2%). CONCLUSIONS AND RELEVANCE Among adolescents followed up over 2 years, there was a statistically significant but modest association between higher frequency of digital media use and subsequent symptoms of ADHD. Further research is needed to determine whether this association is causal.
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Affiliation(s)
- Chaelin K. Ra
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Junhan Cho
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Matthew D. Stone
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine
| | - Julianne De La Cerda
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | | | - Irene Tung
- Department of Psychology, University of California, Los Angeles
| | - Steve S. Lee
- Department of Psychology, University of California, Los Angeles
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
- Department of Psychology, University of Southern California, Los Angeles
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Goldenson NI, Leventhal AM, Stone MD, McConnell RS, Barrington-Trimis JL. Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents. JAMA Pediatr 2017; 171:1192-1199. [PMID: 29059261 PMCID: PMC5779618 DOI: 10.1001/jamapediatrics.2017.3209] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research indicates that electronic cigarette (e-cigarette) use (vaping) among adolescents is associated with the initiation and progression of combustible cigarette smoking. The reasons for this association are unknown. OBJECTIVE To evaluate whether use of e-cigarettes with higher nicotine concentrations is associated with subsequent increases in the frequency and intensity of combustible cigarette smoking and vaping. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study involving students from 10 high schools in the Los Angeles, California, metropolitan area, surveys were administered during 10th grade in the spring (baseline) and 11th grade in the fall (6-month follow-up) of 2015 to students who reported using e-cigarettes within the past 30 days and the nicotine concentration level they used at baseline. EXPOSURES Self-report of baseline e-cigarette nicotine concentration of none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL) typically used during the past 30 days. MAIN OUTCOMES AND MEASURES Frequency of combustible cigarette smoking and e-cigarette use within the past 30 days (0 days [none], 1-2 days [infrequent], or ≥3 days [frequent]) and daily intensity of smoking and vaping (number of cigarettes smoked per day, number of vaping episodes per day, and number of puffs per vaping episode) at the 6-month follow-up. RESULTS The analytic sample included 181 students (96 boys [53.0%] and 85 girls [47.0%]; mean [SD] age, 16.1 [0.4] years). Each successive increase in nicotine concentration (none to low, low to medium, and medium to high) vaped was associated with a 2.26 (95% CI, 1.28-3.98) increase in the odds of frequent (vs no) smoking and a 1.65 (95% CI, 1.09-2.51) increase in the odds of frequent (vs no) vaping at follow-up after adjustment for baseline frequency of smoking and vaping and other relevant covariates. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up (adjusted rate ratio [RR], 7.03; 95% CI, 6.11-7.95). An association with a significantly greater number of vaping episodes per day was found with use of low (adjusted RR, 3.32; 95% CI, 2.61-4.03), medium (adjusted RR, 3.32; 95% CI, 2.54-4.10), and high (adjusted RR, 2.44; 95% CI, 1.63-3.24) nicotine concentrations (vs no nicotine) at baseline. Similar results were found for the number of puffs per vaping episode for low (adjusted RR, 2.05; 95% CI, 1.41-2.70), medium (adjusted RR, 3.39; 95% CI, 2.66-4.11), and high (adjusted RR, 2.23; 95% CI, 1.42-3.03) nicotine concentrations. CONCLUSIONS AND RELEVANCE The results of this study provide preliminary evidence that use of e-cigarettes with higher nicotine concentrations by youths may increase subsequent frequency and intensity of smoking and vaping.
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Affiliation(s)
- Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA,Department of Psychology, University of Southern California, Los Angeles, CA,Corresponding author: Adam M. Leventhal, University of Southern California Keck School of Medicine, 2001 N Soto Street, 3rd Floor 302-C, Los Angeles, CA 90032, Tel: 323-442-2359; Fax: 323-442-2359;
| | - Matthew D. Stone
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Rob S. McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
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Leventhal AM, Urman R, Barrington-Trimis JL, Goldenson NI, Gallegos K, Chou CP, Wang K, Berhane K, Cruz TB, Pentz MA, Unger J, McConnell RS. Perceived stress and poly-tobacco product use across adolescence: Patterns of association and gender differences. J Psychiatr Res 2017; 94:172-179. [PMID: 28738287 PMCID: PMC5634516 DOI: 10.1016/j.jpsychires.2017.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/09/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
Perceived stress-an endophenotype indicative of the tendency to appraise stress as frequent, unpredictable and unmanageable-is associated with adolescent cigarette smoking. It is unclear whether this association: (1) extends to alternative tobacco products, like electronic cigarettes and hookah (tobacco water pipe), which are increasingly popular among youth, and (2) differs by gender. In this report, data were drawn from a population-based longitudinal cohort of youth in Southern California. Perceived stress was assessed at baseline (7th or 8th grade; 2010). Electronic cigarette, hookah, combustible cigarette, and cigar use were assessed at a 4-year follow-up (11th or 12th grade; 2014). After adjusting for confounders, polytomous logistic regressions showed that a standardized baseline perceived stress score (M = 0, SD = 1) predicted electronic cigarette, hookah, combustible cigarette, and cigar use and a poly-tobacco use index at the 4-year follow-up in the overall sample. Interactions between perceived stress and gender were also observed (Interaction Ps < 0.05), which demonstrated that the association of perceived stress with tobacco product use and poly-use were stronger in females (ORs for current use range: 1.47 to 1.72) than males (ORs range: 0.93 to 1.31). Adjusting for baseline perceived stress, the change in perceived stress from baseline to follow-up was also positively associated with use and poly-use of most tobacco products in females and in males to some extent. In the current era in which teen use of alternative tobacco products is increasingly common, adolescent tobacco use and poly-use research and prevention strategies should address gender-specific origins of tobacco product use risk and consider perceived stress and other emotional endophenotypes in such risk pathways.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States.
| | - Robert Urman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Katia Gallegos
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Chih Ping Chou
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Kejia Wang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Mary Ann Pentz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jennifer Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Rob S McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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Rudy A, Leventhal A, Goldenson NI, Eissenberg T. Assessing electronic cigarette effects and regulatory impact: Challenges with user self-reported device power. Drug Alcohol Depend 2017; 179:337-340. [PMID: 28843084 PMCID: PMC5599371 DOI: 10.1016/j.drugalcdep.2017.07.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) aerosolize liquids for user inhalation that usually contain nicotine. ECIG nicotine emission is determined, in part, by user behavior, liquid nicotine concentration, and electrical power. Whether users are able to report accurately nicotine concentration and device electrical power has not been evaluated. This study's purpose was to examine if ECIG users could provide data relevant to understanding ECIG nicotine emission, particularly liquid nicotine concentration (mg/ml) as well as battery voltage (V) and heater resistance (ohms, Ω) - needed to calculate power (watts, W). METHODS Adult ECIG users (N=165) were recruited from Los Angeles, CA for research studies examining the effects of ECIG use. We asked all participants who visited the laboratory to report liquid nicotine concentration, V, and Ω. RESULTS Liquid nicotine concentration was reported by 89.7% (mean=9.5mg/ml, SD=7.3), and responses were consistent with the distribution of liquids available in commonly marketed products. The majority could not report voltage (51.5%) or resistance (63.6%). Of the 40 participants (24.8%) who reported voltage and resistance, there was a substantial power range (2.2-32,670W) the upper limit of which exceeds that of the highest ECIG reported by any user to our knowledge (i.e., 2512W). If 2512W is taken as the upper limit, only 30 (18.2%) reported valid results (mean 237.3W, SD=370.6; range=2.2-1705.3W). CONCLUSIONS Laboratory, survey, and other researchers interested in understanding ECIG effects to inform users and policymakers may need to use methods other than user self-report to obtain information regarding device power.
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Affiliation(s)
- Alyssa Rudy
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Adam Leventhal
- University of Southern California Health, Emotion, and Addiction Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Nicholas I. Goldenson
- University of Southern California Health, Emotion, and Addiction Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.
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Affiliation(s)
- Matthew G Kirkpatrick
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Nicholas I Goldenson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jon-Patrick Allem
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Ann Pentz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Lam CN, Goldenson NI, Burner E, Unger JB. Cultural buffering as a protective factor against electronic cigarette use among Hispanic emergency department patients. Addict Behav 2016; 63:155-60. [PMID: 27513593 DOI: 10.1016/j.addbeh.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hispanics in the U.S. historically use tobacco at lower rates than other racial and ethnic groups. Cultural buffering, the process by which aspects of traditional Hispanic culture delay the adoption of unhealthy behaviors, is believed to be a protective factor against tobacco use. Electronic cigarettes (e-cigarettes) are a new tobacco product that have not been extensively studied, and it is unknown if cultural factors that protect against tobacco use will buffer against e-cigarette use among the Hispanic population. METHODS This cross-sectional study was conducted at the emergency department (ED) in a safety-net hospital in 2014. Patients visiting the ED participated in a survey assessing demographics and substance use. Cultural buffering was operationalized as participants' primary language spoken at home. Multivariate logistic regression and generalized estimating equations examined the association between Hispanic cultural buffering and e-cigarette ever-use. RESULTS Of the 1476 Hispanic ED patients (age: 46.6M±14.5SD, 49.3% male), 7.6% reported e-cigarette ever-use and 11.1% reported current combustible cigarette use. In adjusted models, Spanish speakers were half as likely to report e-cigarette ever-use (O.R.: 0.54, 95% C.I.: 0.34-0.84, p=0.007), compared with English speakers. Combustible cigarette use remained the most significant factor associated with e-cigarette ever-use (O.R.: 9.28, 95% C.I.:7.44-11.56, p<0.001). In higher-income neighborhoods, English speakers reported e-cigarette ever-use at higher rates than Spanish speakers (28.2% vs. 5.9%, p<0.001). CONCLUSIONS Cultural buffering was protective against e-cigarette ever-use, especially in higher-income neighborhoods. These results support research on culturally-sensitive prevention programs for new and emerging tobacco products in Hispanic communities.
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Affiliation(s)
- Chun Nok Lam
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Goldenson NI, Kirkpatrick MG, Barrington-Trimis JL, Pang RD, McBeth JF, Pentz MA, Samet JM, Leventhal AM. Effects of sweet flavorings and nicotine on the appeal and sensory properties of e-cigarettes among young adult vapers: Application of a novel methodology. Drug Alcohol Depend 2016; 168:176-180. [PMID: 27676583 PMCID: PMC5086287 DOI: 10.1016/j.drugalcdep.2016.09.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Product characteristics that impact e-cigarette appeal by altering the sensory experience of vaping need to be identified to formulate evidence-based regulatory policies. While products that contain sweet flavorings and produce a "throat hit" (i.e., desirable airway irritation putatively caused by nicotine) are anecdotally cited as desirable reasons for vaping among young adults, experimental evidence of their impact on user appeal is lacking. This experiment applied a novel laboratory protocol to assess whether: (1) sweet flavorings and nicotine affect e-cigarette appeal; (2) sweet flavorings increase perceived sweetness; (3) nicotine increases throat hit; and (4) perceived sweetness and throat hit are associated with appeal. METHODS Young adult vapers (N=20; age 19-34) self-administered 20 standardized doses of aerosolized e-cigarette solutions varied according to a 3 flavor (sweet [e.g., cotton candy] vs. non-sweet [e.g., tobacco-flavored] vs. flavorless)×2 nicotine (6mg/mL nicotine vs. 0mg/mL [placebo]) double-blind, cross-over design. Participants rated appeal (liking, willingness to use again and perceived monetary value), perceived sweetness and throat hit strength after each administration. RESULTS Sweet-flavored (vs. non-sweet and flavorless) solutions produced greater appeal and perceived sweetness ratings. Nicotine produced greater throat hit ratings than placebo, but did not significantly increase appeal nor interact with flavor effects on appeal. Controlling for flavor and nicotine, perceived sweetness was positively associated with appeal ratings; throat hit was not positively associated with appeal. CONCLUSIONS Further identification of compounds in e-cigarette solutions that enhance sensory perceptions of sweetness, appeal, and utilization of e-cigarettes are warranted to inform evidence-based regulatory policies.
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Affiliation(s)
- Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Julia F McBeth
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Mary Ann Pentz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Jonathan M Samet
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Psychology, University of Southern California, Los Angeles, CA, United States.
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Pang RD, Kirkpatrick MG, Goldenson NI, Guillot CR, Leventhal AM. Asians compared to Whites show increased response to d-amphetamine on select subjective and cardiovascular measures. Pharmacol Biochem Behav 2016; 144:73-7. [PMID: 26952590 DOI: 10.1016/j.pbb.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Identifying factors that moderate subjective response to stimulants is important for understanding individuals at risk for abusing these drugs. Some research suggests that Asians may respond differently to stimulants than other races, but controlled human laboratory research of stimulant administration effects in Asians is scant. METHODS In this double-blind counterbalanced within-subject study, healthy stimulant-naïve participants (N = 65; 55% Asian; 63% female; age 18-35) received a single dose of 20-mg oral d-amphetamine or placebo on separate days. At each testing day, subjective measures of abuse liability and cardiovascular assessments were administered at repeated intervals before and after drug administration over a 4-hour period. RESULTS Asians (vs. Whites) demonstrated greater d-amphetamine-induced increases in diastolic blood pressure and ratings of 'Feel High' and 'Like Drug'. CONCLUSIONS Asian and White healthy young adults may differ in certain subjective and cardiovascular responses to acute doses of d-amphetamine. Such individual differences could help explain between-person differences in abuse potential of d-amphetamine and other stimulants.
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Affiliation(s)
- Raina D Pang
- Department of Preventive Medicine, University of Southern California.
| | | | | | - Casey R Guillot
- Department of Preventive Medicine, University of Southern California
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California; Department of Psychology, University of Southern California
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Goldenson NI, Pang RD, Leventhal AM. Associations between ADHD symptoms and smoking outcome expectancies in a non-clinical sample of daily cigarette smokers. Am J Addict 2016; 25:152-9. [PMID: 26871681 DOI: 10.1111/ajad.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/18/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Smoking outcome expectancies for positive reinforcement (PR: beliefs that smoking produces desirable outcomes) and negative reinforcement (NR: beliefs that smoking alleviates negative affect) are modifiable cognitive manifestations of affect-mediated smoking motivation. Based on prior data and theory, we hypothesized that NR and PR expectancies are associated with ADHD symptom levels in a non-clinical sample of cigarette smokers. (Am J Addict 2016; XX:XX -XX) METHODS: Daily cigarette smokers (N = 256) completed self-report measures of ADHD symptoms and smoking outcome expectancies. Cross-sectional associations of overall ADHD symptomatology and the ADHD symptom dimensions of inattention (IN: difficulty concentrating and distractibility) and hyperactivity impulsivity (HI: poor inhibitory control and motor activity restlessness) with PR and NR smoking outcome expectancies were examined. RESULTS Higher levels of overall, IN and HI ADHD symptoms were positively associated with NR smoking expectancies after statistically controlling for anxiety, depression, alcohol/drug use problems, nicotine dependence, and other smoking expectancies. Although neither HI nor IN symptom dimensions exhibited empirically unique relations to NR expectancies over and above one another, the collective variance across IN and HI was associated with NR expectancies. PR expectancies were not associated with ADHD symptoms. DISCUSSION AND CONCLUSIONS Although PR and NR expectancies may be important etiological influences in the overall population of smokers, NR outcome expectancies appear to be disproportionately expressed in smokers with elevated ADHD symptoms. Cognitive manifestations of NR motivation, which may be modifiable via intervention, are prominent in smokers with elevated ADHD symptoms. SCIENTIFIC SIGNIFICANCE Beliefs that smoking alleviates negative affect may underlie ADHD-smoking comorbidity.
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Affiliation(s)
- Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.,Department of Psychology, University of Southern California, Los Angeles, California
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Kirkpatrick MG, Goldenson NI, Kapadia N, Kahler CW, de Wit H, Swift RM, McGeary JE, Sussman S, Leventhal AM. Emotional traits predict individual differences in amphetamine-induced positive mood in healthy volunteers. Psychopharmacology (Berl) 2016; 233:89-97. [PMID: 26429791 PMCID: PMC4703469 DOI: 10.1007/s00213-015-4091-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/21/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previous research on emotional correlates of individual differences in subjective responses to D-amphetamine has focused on relatively broad personality traits. Yet, emotional functioning is best characterized by several narrow subcomponents, each of which may contribute uniquely to amphetamine response. Here, we examine several specific subdomains of emotional functioning in relation to acute amphetamine response. METHOD At a baseline session, healthy stimulant-naive volunteers (N = 97) completed measures of several subdomains of baseline trait emotional functioning and then completed two counterbalanced experimental sessions during which they received a single oral dose of 20 mg D-amphetamine or placebo. Acute subjective drug response measures were completed at repeated intervals before and after drug administration. Data from subjective measures that were significantly modulated by amphetamine were reduced using principal component analysis (amphetamine or placebo) into three higher-order factors of "positive mood," "arousal," and "drug high." Amphetamine did not significantly alter any "negative" subjective states. Separate multiple regression analyses were conducted regressing these three drug factors on baseline trait emotional functioning scales. RESULTS The combined set of trait emotional functioning indicators accounted for approximately 22 % of the variance in acute amphetamine-induced positive mood changes. Greater anticipatory pleasure and greater anxious distress each uniquely predicted greater amphetamine-induced positive mood. Trait emotional functioning did not significantly predict amphetamine-induced changes in arousal or drug high. DISCUSSION Emotional traits appear to moderate drug-induced positive mood but not other dimensions of amphetamine effects. Different facets of emotional functioning may differentially modulate amphetamine's subjective effect profile.
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Affiliation(s)
- Matthew G. Kirkpatrick
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Nahel Kapadia
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | | | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Robert M. Swift
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence VA Medical Center, Providence, Rhode Island
| | - John E. McGeary
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence VA Medical Center, Providence, Rhode Island
| | - Steve Sussman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Adam M. Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
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Goldenson NI, Kirkpatrick MG, Leventhal AM. Initial Validation of the Pleasure and Health Behavior Inventory - A Measure of Motivation to Engage in Health-damaging Behavior to Overcome Deficient Pleasure. Am J Health Behav 2015; 39:652-64. [PMID: 26248175 DOI: 10.5993/ajhb.39.5.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To validate the Pleasure and Health Behavior Inventory (PHBI) - a novel 7-item self-report measure of motivation to engage in addictive, health-damaging behaviors (ie, substance use, gambling, casual sex, overeating) to overcome deficient pleasure. METHODS In a cross-sectional analysis of daily cigarette smokers (N = 206), we examined the PHBI's internal consistency, factor structure, and convergent validity with smoking-related characteristics, alcohol and drug use, BMI and other factors. RESULTS The PHBI had adequate internal consistency and a largely unifactorial structure. The PHBI composite, which amalgamates motivation to engage in several types of unhealthy behaviors for pleasure, positively correlated with unhealthy behaviors. Individual PHBI items were associated with corresponding behavior-specific outcomes. CONCLUSIONS The PHBI may be useful for understanding the psychological underpinnings of health-damaging behavior.
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Affiliation(s)
- Nicholas I Goldenson
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
| | - Matthew G Kirkpatrick
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA
| | - Adam M Leventhal
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, USA.
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Gabrielian S, Bromley E, Hellemann GS, Kern RS, Goldenson NI, Danley ME, Young AS. Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders. J Clin Psychiatry 2015; 76:e469-76. [PMID: 25919839 PMCID: PMC4620999 DOI: 10.4088/jcp.14m09229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/23/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to understand the housing trajectories of homeless consumers with serious mental illness (SMI) and co-occurring substance use disorders (SUD) and to identify factors that best predicted achievement of independent housing. METHOD Using administrative data, we identified homeless persons with SMI and SUD admitted to a residential rehabilitation program from December 2008 to November 2011. Our primary outcome measure was independent housing status. On a random sample (N = 36), we assessed a range of potential predictors of housing outcomes, including symptoms, cognition, and social/community supports. We used the Residential Time-Line Follow-Back (TLFB) Inventory to gather housing histories since exiting rehabilitation and to identify housing outcomes. We used Recursive Partitioning (RP) to identify variables that best differentiated participants by these outcomes. RESULTS We identified 3 housing trajectories: stable housing (n = 14), unstable housing (n = 15), and continuously engaged in housing services (n = 7). In RP analysis, 2 variables (Symbol Digit Modalities Test [SDMT], a neurocognitive speed of processing measure, and Behavior and Symptom Identification Scale [BASIS-24] Relationships subscale, which quantifies symptoms affecting relationships) were sufficient to capture information provided by 26 predictors to classify participants by housing outcome. Participants predicted to continuously engage in services had impaired processing speeds (SDMT score < 32.5). Among consumers with SDMT score ≥ 32.5, those predicted to achieve stable housing had fewer interpersonal symptoms (BASIS-24 Relationships subscale score < 0.81) than those predicted to have unstable housing. This model explains 57% of this sample's variability and 14% of this population's variability in housing outcomes. CONCLUSIONS Because cognition and symptoms influencing relationships predicted housing outcomes for homeless adults with SMI and SUD, cognitive and social skills training may be useful for this population.
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Affiliation(s)
- Sonya Gabrielian
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg 210A, Los Angeles, CA 90073
| | - Elizabeth Bromley
- Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
| | - Gerhard S. Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
| | - Robert S. Kern
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nicholas I. Goldenson
- Department of Preventive Medicine, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
| | - Megan E. Danley
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Alexander S. Young
- Department of Psychiatry, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA., Department of Veterans Affairs VISN22 Mental Illness Research and Education Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., VA Center for the Study of Healthcare Innovation, Implementation, and Policy, North Hills, CA, USA
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